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International Journal of Sexual Health logoLink to International Journal of Sexual Health
. 2021 Mar 1;33(2):210–221. doi: 10.1080/19317611.2021.1884164

Reproductive and Sexual Health in Males with Physical, Hearing, and Vision Disabilities

Ergül Aslan 1, Zehra Acar 1,✉, Büşra Yılmaz 1
PMCID: PMC10929575  PMID: 38596751

Abstract

Objective

This study aimed to determine reproductive health, sexual functions, and sexual satisfaction levels of males with disabilities. Methods: The study had a cross-sectional, descriptive, and correlational design and was conducted on 136 males with disabilities. Data was collected using an introduction form, International Index of Erectile Function, the Erectile Performance Anxiety Index (EPAI), the Premature Ejaculation Profile (PEP), and the Sexual Satisfaction Scale (SSS). Results: The total EPAI score was 19.86 ± 8.98(10–50), the total PEP score was 9.91 ± 4.20(0–16) and the total SSS score was 86.79 ± 18.20(44–119). Conclusions: Education and counseling on reproductive and sexual health should be given based on their individual needs.

Keywords: Hearing disability, physical disability, sexual function, sexual satisfaction, vision disability

Introduction

According to the International Classification of Functioning, Disability and Health (ICF), disorder is defined as a deviation or loss in physical structure, dysfunction is defined as a loss of function caused by the disorder, and disability is defined as prevention of the individuals from social participation and the limitation of their social roles due to the restriction of everyday life activities (ICF, 2001). There are many types of disabilities, such as those that affect a person’s physical functioning/mobility, vision, hearing, and mental health (Centers for Disease Control and Prevention, 2020). The main characteristic of a physical disability is that some aspect of a person's physical functioning, usually either their mobility, dexterity, or stamina, is affected (ANU, 2020). Physical disabilities include dysfunctions such as brain or spinal cord injuries, multiple sclerosis, cerebral palsy, respiratory disorders, and epilepsy (Tough et al., 2017). Visual impairments include low vision and blindness and refer to any degrees of impairment in a person’s ability to see that affects his or her daily life (Sapp, 2010). The World Health Organization (WHO) defines disabling hearing loss in adults as hearing loss greater than 40 decibels (dB; WHO, 2020a). According to the World Disability Report, which was published for the first time by the WHO and the World Bank, approximately 15% of the world population consisted of individuals with disabilities (WHO, 2011). It is estimated that a minimum of 2.2 billion people have a vision disability or are blind (WHO, 2019); and 466 million people (6.1% of the world population) suffer from a hearing disability (WHO, 2020a).

People with disabilities face various problems from birth or from the moment they develop a disability. One of these problems is related to the reproductive health and their sexual life. Reproductive health refers not only to the absence of a disease or disability regarding the reproductive system, functions, and process but also having a state of complete physical, mental, and social well-being regarding these. Reproductive health refers to having the ability to maintain a safe and satisfactory sexual life, reproductive capabilities, and the freedom to decide when and how often to perform these (WHO, 2020b). It has been reported that individuals with disabilities do not have sufficient information about reproductive and sexual health (Nguyen et al., 2019). In addition, they have more difficulty accessing reproductive and sexual health services compared to healthy individuals (WHO, 2010). These difficulties include problems in accessing healthcare institutions, insufficient equipment and hardware, negative experiences and barriers to communicate with healthcare personnel, and an insufficient level of knowledge and skills of healthcare professionals regarding the health of those with disabilities (Eide et al., 2015). A study reported that 55% of males with disabilities had physical difficulty in accessing sexual and reproductive health services, and 50% encountered negative attitudes of health professionals while receiving these services (Ahumuza et al., 2014). It has been reported that males with disabilities are rarely admitted to healthcare institutions for reproductive health services (Mavuso & Maharaj, 2015). It has been determined that individuals with disabilities, who have difficulty in accessing these services, have more needs for family planning that are not met (Mavuso & Maharaj, 2015). Moreover, it has been stated that individuals with disabilities have experienceD sexual intercourse at younger ages, may exhibit unsafe sexual behaviors, and are more vulnerable to sexually transmitted diseases (particularly HIV/AIDS; França et al., 2019; Porat et al., 2012; Touko et al., 2010).

Sexuality is an important component of quality of life for all individuals, regardless of age or ability status. The sexual lives of people with disabilities are an unknown and often neglected issue. Several studies have also pointed out to the presence of a belief that individuals with disabilities are either asexual or hypersexual and have inappropriate sexual intercourses and marriage (França et al., 2019; Nguyen et al., 2019). However, studies have shown that individuals with disabilities have normal sexual lives, just like other individuals. Reasons such as restrictions encountered due to the ability status, economic problems, attitudes and behaviors toward people with disabilities, and difficulty finding partners all negatively affect their sexual lives (Addlakha et al., 2017; França et al., 2019; Nguyen et al., 2019). People with disabilities who live with their families may especially experience restrictive and oppressive attitudes toward sexuality; therefore, they may be devoid of the context and opportunity to establish emotional and sexual relationships (Pereira et al., 2018).

Disability is a condition that does not affect or slightly affects sexuality in some individuals; however, it has various negative effects on other individuals (Pereira et al., 2018). The literature particularly focuses on the sexuality of individuals with physical disabilities among all types of disabilities. Physical restrictions in individuals with disabilities can make both the physical and emotional aspects of sexual intercourse difficult for people with disabilities, as well as their spouses/partners. Functional limitations in males with physical disabilities may lead to difficulty having and maintaining erection, as well as decreased sensation, sexual desire, and orgasm (Pereira et al., 2018; Rowen et al., 2015). A qualitative study showed that individuals with physical disabilities had more erectile dysfunction problems. It also revealed that they often face other problems related to sexual positions, dependency on others and on medications, feel less attractive, and lack sexual ability (Pereira, 2020). Reproductive and sexual health are affected negatively in individuals with disabilities due to the myths and taboos regarding sexuality, congenital disadvantages, difficulty in accessing health services, and risk of sexually transmitted diseases (França et al., 2019).

For these reasons, the aim of this study is to determine the reproductive health, sexual functions and sexual satisfaction levels of males with disabilities.

Materials and methods

Design

This study was carried out as a cross-sectional, descriptive and correlational research between September 2017 and September 2019 with the aim of determining the reproductive health, sexual functions, and sexual satisfaction levels of males with disabilities.

Participants

This study was carried out with the help of non-governmental organizations in the city of Istanbul, whose members were the individuals with disabilities. The sample of the study consisted of the males with disabilities residing in the city of … . Among the probabilistic sampling methods, simple random sampling method was used. The males with physical, vision, and hearing disabilities who were available and accessed through the disability associations during the study period and who met the inclusion criteria and agreed to participate in the study were included in the sample. The inclusion criteria were as follows: having a physical disability, not having any mental disabilities, being male aged 18–65 years, being sexually active, and volunteering to participate in the study. Because the aim of the study was to determine the reproductive health, sexual functions, and sexual satisfaction levels of disabled males, sexually active disabled males were included. The information in the voluntary consent form was explained to the participants, and their verbal consents were obtained. Data obtained from 136 males with disabilities were analyzed.

Data collection

Data was collected by using two different methods: face-to-face interviews and online interactive interviews considering the opportunities of access to the individuals with different types of disabilities. In cooperation with nongovernmental organizations for individuals with disabilities, whose members were individuals with physical disabilities and vision disabilities, the study was conducted in the centers of these organizations by creating a suitable environment.

Expert opinions were obtained to ensure that the data collection tools were understandable for all disability groups, and necessary changes were made. The forms were tested in a pilot study on three disabled individuals from each disability group. The data obtained from the pilot study were not included in the data analysis.

After the data collection forms were revised, data was collected through face-to-face interviews and online surveys from participants with physical disabilities and vision disabilities, and interactive videos from participants with hearing disabilities. For the participants who were unable to read, write, and mark due to their disabilities, the researchers read the questions and recorded the participants’ answers. Data collection via face-to-face interviews took an average of 45 min per person.

Some questions in the data collection forms were simplified and visualized for the participants with hearing disabilities. The pilot study showed that participants with hearing disabilities had no problem with understanding and filling in the International Index of Erectile Function (IIEF) and the Erectile Performance Anxiety Index scales (EPAI), but had problems with Premature Ejaculation Profile (PEP) and the Sexual Satisfaction Scale (SSS). Therefore, two scales could not be applied to the participants with hearing disabilities. An interactive video platform was established for data collection forms and separate online surveys were created. In the interactive video, the questions were displayed and simultaneously translated into sign language by a translator. After the translation, the question and the options were displayed on the screen. The participants could answer the next question after responding to the displayed question. The survey did not include identity information and it was created so as to ensure that it could be filled in at once. The data collection forms took approximately 30 min to complete. The data were saved on the platform and analyzed. The survey was conveyed to hearing-impaired individuals with the help of the relevant associations.

Measures

An Introduction Form was created by the researchers for data collection. The IIEF, the EPAI, the PEP, and the SSS were administered to evaluate sexual functions more comprehensively.

Introduction form

It consists of 46 questions about sociodemographic characteristics, general health status, reproductive health and sexual life characteristics of the males with disabilities, the characteristics of the spouse/partner, the state of their relationships, and their ways to deal with their sexual problems. There were multiple choice, multiple response, graded, and open-ended questions. The degree of disability was also included in the questions. The Balthazard formula was used to determine the degree of disability in the National Health Insurance System (Yilmaz, 2007).

IIEF

Developed by Rosen et al. (1997), the IIEF is a 5-point Likert-type scale with 15 questions, consisting of five subscales, that is, erectile function (six questions), orgasmic function (two questions), sexual desire (two questions), intercourse satisfaction (three questions) and overall satisfaction (two questions) within the last four weeks. According to erectile function subscale scores, erectile dysfunction is classified as severe (6–10), moderate (11–16), mild-moderate (17–21), mild (22–25), and no erectile dysfunction (26–30). Higher scores obtained from the scale indicated good sexual function and satisfaction. The internal consistency level of the IIEF in this study was very high, with a Cronbach alpha value of 0.947 (Rosen et al., 1997).

EPAI

Developed by Telch and Pujols (2013), the scale has a single subscale and it consists of 10 questions. It evaluates the state of anxiety in males regarding having or maintaining erection during sexual intercourse within the last week. It is a 5-point Likert-type scale with answers ranging from "never" (1) to "always" (5). EPAI scores range from 10 to 50, with higher scores indicating higher performance anxiety. Telch and Pujols found EPAI to have a high level of internal consistency, with a Cronbach alpha value of 0.845 (Telch & Pujols, 2013).

PEP

Defined in DSM-IV-TR (American Psychiatric Association, 2000), it evaluates perceived ejaculation control in men, personal distress associated with ejaculation, difficulty in interpersonal relationships regarding ejaculation, and sexual satisfaction regarding ejaculation. It is a Likert-type scale scored between 0 and 4. It consists of four questions. The total score can be divided and a score between 0 and 4 can be obtained. Higher PEP scores indicate better ejaculation. PEP was found to have a high level of internal consistency in this study, with a Cronbach alpha value of 0.820 (American Psychiatric Association, 2000).

SSS

The scale, which was developed to evaluate the sexual satisfaction levels of women, consisted of 30 items. This 5-point Likert-type scale hadfive subscales called Contentment, Communication, Compatibility, Relational Concern and Personal Concern. The total score ranges between 30 and 150 and it is calculated as follows: Contentment + Communication + Compatibility + (Relational Concern + Personal Concern/2). The sexual satisfaction increases based on the increase in the scores obtained from the scale. The SSS was found to have a very high internal consistency level in this study, with a Cronbach alpha value of 0.932 (Meston & Trapnell, 2005).

Ethical considerations

The approval of the ethics committee was obtained from the Clinical Research Ethics Committee of the Cerrahpaşa Medical Faculty in Istanbul University- Cerahpaşa. Permission was also obtained from the institutions where the research was carried out. The information in the voluntary consent form was explained to the participants, and their verbal consents were obtained. The participants with hearing disabilities were informed about the study, filled out the voluntary consent form on the interactive video screen and started to answer the questionnaire. Rules of courtesy were followed during face-to-face interviews and sufficient time was given to answer the questions. The study was performed in accordance with the “Ethical principles for medical research involving human subjects” of the Helsinki Declaration. The males with disabilities who requested guidance and solutions regarding reproductive health, infertility and sexual problems were referred to the relevant departments of a medical faculty.

Data analysis

A statistical software package was used to analyze the data. Number, percentage, mean, standard deviation and median were used as the descriptive statistical methods. For group comparisons, the nonparametric Kruskal Wallis-H and Mann-Whitney U tests were used. The significance levels were set at p < .01 (highly significant) and p < .05 (significant).

Results

Sociodemographic characteristics

Regarding the distribution of the participants included in the study, 39% (n = 53) had a vision disability, 31.6% (n = 43) had a physical disability and 29.4% (n = 40) had a hearing disability. The mean age of the participants was 33.72 ± 9.35 years (min. = 19, max. =60, med. =32.5). Nearly 40.7% of the participants were university graduates; 65% of the participants were employed and the financial status of 61% was moderate; 93.1% of the participants were married, 86.3% lived with their families, and 65.4% had a disability when they got married. Duration of marriage was 9.56 ± 8.08 years (min. = 1, max. = 7, med. = 7). Sociodemographic and disability characteristics of the participants are presented in Table 1.

Table 1.

Sociodemographic and Disability Characteristics of the Participants (n = 136).

Variable Physical disability (n = 43), M ± SD (min–max) Vision disability (n = 53), M ± SD (min–max) Hearing disability (n = 40), M ± SD (min–max)
Age (years) 31.67 ± 9.12 (20–54) 38.34 ± 9.23 (19–60) 29.80 ± 7.09 (20–46)
Duration of marriage (years) 8.75 ± 9.63 (1–31) 10.85 ± 7.90 (1–36) 7.05 ± 6.72 (1–20)
Duration of disability (years)
 15.95 ± 13.72 (1–54)
 32.41 ± 11.91 (7–58)
 24.43 ± 11.06 (1–44)
 
 n (%)
 n (%)
 n (%)
Education      
 8 years or less (primary education) 14 (33.4) 11 (20.8) 4 (14.2)
 8–12 years (Secondary and high school) 19 (45.2) 13 (24.5) 12 (42.9)
 More than 12 years (university or higher level of education) 9 (21.4) 29 (54.7) 12 (42.9)
Perceived income      
 Low 15 (37.5) 4 (7.5) 7 (28)
 Moderate 24 (60) 37 (69.9) 11 (44)
 High 1 (2.5) 12 (22.6) 7 (28)
Employment      
 Employed 17 (39.5) 44 (83.0) 19 (70.4)
 Unemployed 26 (60.5) 9 (17.0) 8 (29.6)
Marital status      
 Married 39 (90.7) 49 (92.5) 20 (50)
 Single 4 (9.3) 4 (7.5) 20 (50)
Partner's disability status      
 Yes 6 (16.3) 27 (55.2) 22 (55)
 No 31 (83.7) 22 (44.8) 18 (45)
Having children      
 Yes 16 (37.2) 30 (56.6) 6 (15.0)
 No 27 (62.8) 23 (43.4) 34 (85.0)
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Disability characteristics

Duration of disability was 25.03 ± 14.34 years (min. = 1, max. = 58, med. =26), with a disability degree of 88.54 ± 12.14 (min. = 49, max. = 90, med. = 49) out of 100. The spouses/partners of 50.9% of the participants also had disabilities. Concerning disabilities of the spouses/partners, 47.2% had a physical disability, 41.5% had a vision disability, and 11.3% had a hearing disability. Duration of disability in the spouse/partner was 28.00 ± 10.76 years (min. = 1, max. = 48, med. = 28). Thirty-eight percent of the participants had one or more children. Nearly 52% of the participants reported that they had a disability since birth due to different reasons such as consanguineous marriage (21.3%), genetic factors, accidents, and various diseases. Concerning the degree of hearing disabilities, 55.6% had an advanced hearing loss and 33.3% had a moderate hearing loss; 7.6% of the participants had a chronic disease and the most common ones were diabetes mellitus, hypertension, and coronary heart disease; and 37.9% of the participants were smokers and 22.8% had the habit of alcohol use.

The rate of need for assistance in maintaining everyday lives was 32.4%; the vast majority received support from their spouses/partners and family members. Twenty-two percent of the participants had other family members with disabilities such as their mothers, fathers, and siblings. Table 1 shows some characteristics of the participants according to types of their disabilities.

Reproductive health

In terms of reproductive health, 71.3% of the participants had basic knowledge about sexuality, 61.9% reported that they acquired sexual information from their friends, 53.6% from media such as television and newspaper, 25.8% from school, 17.5% from healthcare personnel, and 12.4% from their families.

Nearly 98% of the participants said that they knew about family planning methods. Known methods were condoms in 68.1%, hormonal tablets in 50.5%, withdrawal in 28.7%, intrauterine devices in 20.2%, hormonal injection in 8.5%, tubal ligation in 3.2%, and vasectomy in 2.1%. The rate of using family planning methods was 60.6%. The methods used were condoms in 52.4%, withdrawal in 34.9%, hormonal tablets in 17.5%, intrauterine devices in 17.5%, and hormonal injection in 4.8% of the participants.

Nearly 46% of the participants noted that they knew about the family planning methods that were useful in preventing sexually transmitted diseases (STDs), with 95.2% mentioning that condoms were protective.

Eighty-point percent of the participants were knowledgeable about STDs. The known diseases were HIV/AIDS in 92.9%, hepatitis B in 73.3%, hepatitis C in 66.3%, gonorrhea in 57%, syphilis in 41.9%, HPV in 33.3%, genital herpes in 29.1%, chancroid in 18.6%, pediculosis pubis in 16.3%, chlamydia in 5.8%, and trichomoniasis in 4.7% of the participants. All the participants reported that they never had a STD. Table 2 shows characteristics of reproductive health according to types of disabilities.

Table 2.

Reproductive Health and Sexual Function Characteristics of the Participants (n = 136).

Variable Physical disability (n = 43), M ± SD (min–max) Vision disability, M ± SD (min–max) (n = 53) Hearing disability (n = 40), M ± SD (min–max)
Age at the first sexual intercourse 19.61 ± 3.98 (15–32) 20.69 ± 4.42 (11–32) 21.93 ± 5.44 (15–32)
  n (%) n (%) n (%)
Receiving basic information about sexuality
 Yes 32 (74.4) 50 (96.2) 15 (88.3)
 No 11 (25.6) 2 (3.8) 2 (11.7)
Sources of sexuality-related information*      
 Family 5 (11.6) 5 (9.4) 2 (6.9)      
 Friends 20 (46.5) 28 (52.8) 12 (41.4)      
 School 6 (14) 14 (26.4) 5 (17.4)      
 Health professionals 6 (14) 9 (17) 2 (6.9)      
 TV-newspaper-magazine 13 (30.2) 31 (58.5) 8 (27.4)      
Knowing about family planning methods      
 Yes 42 (97.7) 51 (96.2) **      
 No 1 (2.3) 2 (3.8)        
Using family planning methods            
 Yes 19 (44.2) 34 (66.6) 10 (25)      
 No 24 (55.8) 17 (33.4) 30 (75)      
Knowing sexually transmitted diseases      
 Yes 28 (65.1) 52 (98.1) 6 (54.5)      
 No 15 (34.9) 1 (1.9) 5 (45.5)      
Frequency of sexual intercourse            
 Once a day 3 (7.7) 4 (7.5) 3 (33.4)      
 4–5 times a week 1 (2.5) 3 (5.7) 1 (11.1)      
 2–3 times a week 9 (23) 23 (43.4) 1 (11.1)      
 Once a week 5 (12.9) 13 (24.5) 1 (11.1)      
 Fortnightly 9 (23) 3 (5.7) 1 (11.1)      
 Once a month 12 (30.9) 7 (13.2) 2 (22.2)      
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*More than one response was given.

**This question was not asked to the participants with hearing disabilities.

Sexual function

The age of first sexual intercourse was 20.54 ± 4.48 years (min. 11, max. 32, med.20). The frequency of sexual intercourse was once a day in 10%, four to five times a week in 5%, three to four times a week in 33%, once a week in 19%, fortnightly in 12%, and once a month in 21%.

The participants rated their marriage or relationship with their spouses/partners as 6.81 ± 2.64 (med. =7), ranging between 1 (very poor) and 10 (very good). They rated their sexual intercourse with their spouses/partners as 6.62 ± 2.58 (med. = 7), ranging between between 1 (very poor) and 10 (very good). In this evaluation, 36.1% of the participants scored their sexual intercourse as 5 and below, and 12.5% attributed sexual intercourse problems to themselves, 8.1% their spouse/partner, 8.8% both themselves and their partners, and 2.9% environmental factors. The participants noted that sexual intercourse problems were often caused by physical problems (limited mobility, physical difficulties, inability to establish eye contact etc.), communication problems (not talking about sexuality, sexual problems etc.) and psychological problems that couples have. They also attributed sexual intercourse problems to environmental factors such as oppressive attitudes of families toward sexuality and unsuitable home conditions (physical conditions and crowding of the house). Of all the participants reporting that the problems in intercourse were related to themselves, 48.1% mentioned physical problems, 29.6% communication problems and 22.2% mental problems. Regarding the spouse/partner-related problems, 57.7% reported communication problems, 26.9% reported mental problems and 15.7% reported physical problems. Concerning the problems related to environmental factors, 85.8% reported physical problems, whereas 14.2% reported problems with children and family members. Table 2 shows characteristics of sexual functioning according to types of disabilities.

IIEF, EPAI and PEP scores

Table 3 presents the IIEF and EPAI data by the disability groups. IIEF orgasmic function, sexual desire, overall satisfaction, and total scores were significantly higher in the participants with vision disability compared to other groups.

Table 3.

IIEF and EPAI Data by Disability Groups.

Variables Physical disability (n = 43)
Mean ± SD (min–max)		 Vision disability (n = 53)
Mean ± SD (min–max)		 Hearing disability (n = 40)
Mean ± SD (min–max)		 χ2 p
Erectile function 20.13 ± 8.86 (1–30) 22.13 ± 9.86 (1–30) 19.78 ± 11.03 (1–30 2.419 .298
Orgasmic function 5.90 ± 3.55 (0–10) 7.98 ± 3.06 (0–10) 6.67 ± 4.00 (0–10) 7.066 .029*
Sexual desire 7.90 ± 1.88 (4–10) 8.87 ± 1.55 (3–10) 7.11 ± 3.59 (2–10) 7.394 .025*
Intercourse satisfaction 8.90 ± 4.23 (0–15) 10.28 ± 3.98 (0–15) 7.89 ± 5.58 (0–15) 4.490 .106
Overall satisfaction 6.56 ± 2.49 (2–10) 8.38 ± 2.11 (2–10) 6.89 ± 3.89 (2–10) 12.732 .002*
IIEF total score 49.38 ± 16.11 (13–74) 57.64 ± 17.32 (6–75) 48.33 ± 27.23 (5–73) 7.516 .021*
EPAI total score 24.73 ± 10.78 (10–50) 16.72 ± 6.29 (10–36) 18.13 ± 4.764 (12–28) 13.479 .001**
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Note. IIEF = International Index of Erectile; EPAI = Erectile Performance Anxiety Index. χ2 Kruskal-Wallis Test df = 2. *p < .05. **p < .01.

Erectile function was classified as lack of erectile dysfunction (26–30) in 49.5%, mild (22–25) in 17.8%, severe (6–10) in 16.8%, moderate (11–16) in 7.9%, and mild-moderate (17–21) in 7.9%.

In the entire group, the overall EPAI score was 19.86 ± 8.98 (10–50). The participants with vision disabilities had the minimum EPAI scores, while those with physical disabilities had the maximum scores.

Table 4 presents data from The PEP according to disability groups. PEP scores were found to be significantly higher in the participants with vision disabilities compared to those with physical disabilities.

Table 4.

PEP Data by Disability Groupsa.

Score Physical disability (n = 34), M ± SD (min–max) Vision disability (n = 51), M ± SD (min–max) Total (n = 85), M ± SD (min–max) U p
PEP total score 7.88 ± 4.92 (0–16) 11.25 ± 3.01 (5–15) 9.91 ± 4.20 (0–16) 509.00 .001**
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Note. PEP = Premature Ejaculation Profile; U = Man-Whitney Test. **p < .01.

aNot applied to the hearing disability group.

Sexual satisfaction

Sixty-three percent of the participants reported that they were satisfied with their sexual life. In addition, 30% of these people noted that being healthy, ejaculation later, increased sense of feeling, attractiveness of spouse/partner, harmonious relationship, emotional support, and education are important to increase sexual satisfaction.

Fifty-two percent of the participants reported that they initiated the intercourse with mutual touches, hugging, fondling, looks, kisses, texting, joking and foreplay. In addition, 40% noted that they made arrangements to facilitate intercourse, such as music, odor, lights, and taking precautions against trauma, special positions, supporting the hips with pillows, lubricants, and foreplay.

Thirty-on percent of the participants mentioned that having a disability had a negative impact on their sexual life and 16.9% of them explained that their sexuality was affected by limited mobility, physical difficulties, inability to establish eye contact, inability to have an erection or short duration of erection, needing injection for erection, premature ejaculation, failure to get pleasure, and inability to satisfy their spouses.

The roles of males with disabilities and their partners in initiating sexuality were evaluated and 46.3% were found to ask their spouse/partner if they desired sexual intercourse. To cope with loss of sexual desire, 18% of the participants reported that they interrupted the intercourse, talked to their spouse/partner, paid attention to different things, made use of images with sexual content, used drugs, and avoided stress.

Of all the participants, 12.5% noted that they gave themselves time to cope, talked to their spouse/partner, received support from their spouse for arousal and used food support and drugs such as sprays, injection, or tablets to cope with erectile dysfunction. Regarding solutions, 17% reported that they used condoms and withdrawal to cope with ejaculation problems, prolonged foreplay and used delay drugs. Some reported that they could not find solutions and could not ejaculate.

Table 5 outlines data from the SSS according to disability groups. The SSS subscale scores and overall scores of the participants with vision disabilities were found to be significantly higher compared to those with physical disabilities, except for the scores for the Compatibility subscale.

Table 5.

SSS Data by Disability Groupsa.

Variables Physical disability (n = 38)
Mean ± SD (min–max)		 Vision disability (n = 33)
Mean ± SD (min–max)		 Total (n = 71)
Mean ± SD (min–max)		 U p
Contentment 18.11 ± 4.22 (10–30) 20.15 ± 5.54 (7–29) 19.09 ± 4.97 (7–30) 414.00 .030**
Communication 21.34 ± 4.91 (6–30) 23.85 ± 4.89 (13–30) 22.51 ± 5.02 (6–30) 430.50 .023**
Compatibility 22.11 ± 6.06 (7–30) 23.76 ± 6.91 (9–30) 22.89 ± 6.48 (7–30) 483.50 .133
Concern (Relational) 21.34 ± 6.55 (6–30) 25.00 ± 4.57 (14–30) 23.12 ± 5.90 (6–30) 385.00 .018**
Concern (Personal) 18.94 ± 6.92 (8–30) 23.33 ± 7.41 (6–30) 21.04 ± 7.41 (6–30) 387.00 .012**
SSS total score 81.81 ± 16.39 (44–114) 91.92 ± 18.79 (56.5–119) 86.79 ± 18.20 (44–119) 378.50 .022**
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Note. SSS = Sexual Satisfaction Scale; U = Man-Whitney Test. **p < .01.

aNot applied to the hearing disability group.

Discussion

Sexuality is an important component of quality of life for all individuals. The knowledge levels of individuals with disabilities regarding sexuality have a significant impact on their sexual health (Kassa et al., 2016). Disabled males acquire sexuality-related information from different sources. In 2012, Porat et al. found out that disabled young people mostly received this information from their friends and the media and shared it with their doctors only when they were asked questions or they talked about sexuality. Duh (2000) revealed that healthy individuals had more information about sexuality than individuals with vision disabilities and that healthy adolescents mostly got sexuality-related information from their peers, but that adolescents with vision disabilities received it from their teachers. Another study found that individuals with hearing disabilities had insufficient information about reproductive and sexual health, thereby being more likely to engage in risky sexual behaviors or experience sexual dysfunction (Job, 2004). A study Porat et al. (2012) reported that young people with disabilities and their parents generally had insufficient information about sexual and reproductive health. Likewise, this study revealed that males with disabilities acquired sexual knowledge mostly from their friends and media tools such as television and newspaper. Provision of sexual information by healthcare professionals is an important factor for males with disabilities to have access to accurate information and lead a healthy sexual life.

França et al. (2019) reported that individuals with disabilities are more exposed to unsafe sexual behavior compared to healthy individuals. They determined that individuals with vision disabilities had insufficient information about risk factors of STDs and safe sexual life. Touko et al. (2010) also found that individuals with vision disabilities were more likely to have STDs and unsafe sexual practices. These practices include the age of first intercourse, information about use of condoms, STDs and AIDS, lack of use or misuse of condoms as well as the information, attitudes and practices regarding HIV/AIDS (Touko et al., 2010). The present study showed that most of the males had knowledge of STDs, with none having a history of STDs, which is conflicting with the evidence reported by Touko et al. (2010) and França et al. (2019). This can be ascribed with the cultural dimension of sexuality as well as the fact that the majority of the males with disabilities in the present study have single partners in marriage.

Counseling for family planning is an essential part of sexual and reproductive health care. Providing contraceptive services for individuals with disabilities may require appropriate contraception-based decisions for the individuals, taking account of the nature of their disability and the characteristics of different contraceptive methods (making contraceptive decisions, when to start contraceptive use, which method to use, the duration of use) (Höglund & Larsson, 2019). A study with disabilities determined that 67.4% of males with disabilities experienced sexual intercourse, with only 35% using contraceptives during their first intercourse, 59% having multiple sexual partners, and 24% having a history of STDs (Kassa et al., 2014). Another study on participants with hearing disability showed that 87% had heard of at least one contraceptive method, with the known methods being condoms in 59% and pills in 37%, and 37% reporting to have used condoms in their last sexual intercourse (Rusinga, 2012). Another study on adolescents with disabilities reported that the individuals knew of at least three modern methods; the most well-known and used method was the condom (Burke et al., 2017). Similarly, in the present study, it was determined that the vast majority of the males with physical disabilities knew at least one contraceptive method; the most commonly method was the condom.

It is important for individuals with disabilities to define sexuality not only in terms of its physical aspect but also with all its aspects (Courtois & Charvier, 2015). Brain or spinal cord injuries can disrupt many aspects of sexuality, both physical and psychological. Erectile dysfunction is the most common sexual problem among males with physical disabilities. For men, the problems related to erectile function also lead to ejaculation problems (Courtois & Charvier, 2015). Even in the presence of an apparent physical cause, psychological factors are important for sexual functions. These sexual problems also have an impact on sexual behavior, sexual respect (trust in experiencing a satisfactory and pleasurable intercourse) and sexual satisfaction (McCabe & Taleporos, 2003). Dependence on someone else for care can severely restrict the opportunities of the individuals to express their sexuality freely due to the lack of privacy, overprotective parents or caregivers (McCabe & Taleporos, 2003). In a study comparing sexual functioning in males with and without disabilities, it was observed that males with disabilities encountered greater sexual dysfunction compared to those without disabilities. It was determined that 25.6% of males with disabilities and 15.1% of healthy males experienced at least 2 of 15 sexual difficulties. The most common problems were reported to be imbalance of sexual desire (47.6%), premature ejaculation (43.8%), and sexual dissatisfaction (39.4%; Bollier et al., 2019). In a study by Soler et al. (2018) carried out on males with disabilities experiencing spinal cord injury, the IIEF scores were 27.6/30 for erectile function, 8.8/10 for sexual desire, 11.9/15 for intercourse satisfaction, and 8.7/10 for overall satisfaction. Most males were found to be disappointed with their erection and orgasmic status. Another study reported that males with disabilities experienced premature ejaculation more frequently than healthy males (Altıntas & Gul, 2015). The present study showed that males with physical disabilities experienced erectile dysfunction more frequently compared to other disability groups, with the highest frequency to experience anxiety related to having or maintaining an erection, which is consistent with the literature. Sexual functions are affected negatively in males with physical disabilities. Sexual functions in individuals with physical disabilities affect the level of sexual satisfaction (Smith et al., 2015). A study on individuals with disabilities aged 18–25 years determined that males with orthopedic disabilities generally experienced sexual intercourse fewer times and at lower ages; the group of the individuals with vision disabilities had the highest level of satisfaction. In a study by Retznik et al. (2017) most people with disabilities (68.8%) defined the search for partners as challenging. In another study, males with disabilities stated that their female partners should play a more active role in sexuality, thereby providing better satisfaction. The main determinants of having a positive sexual life were identified as the desire of males with disabilities to adapt to sexual life, foreplay and having an erection during sexual intercourse (Soler et al., 2018). In a study by McCabe and Taleporos (2003), males with physical disabilities reported that they preferred oral intercourse, hugging when naked and watching erotic media for sexual satisfaction. For individuals with physical disabilities, physical restrictions create problems regarding positions during sexual intercourse. In another study on individuals with physical disabilities, males with disabilities reported that they used a fixed sexual position if their partners also had a disability, and were not able to use their bodies effectively during intercourse, which affected their level of satisfaction. They stated that they tried new positions to increase their level of satisfaction and watched pornographic videos to increase arousal (Nguyen et al., 2019). In the present study, the males with disabilities mentioned the attraction of their spouse/partner, harmonious relationship, emotional support, taking precautions against trauma and special positions such as using pillows for hip support to increase their sexual satisfaction and facilitate the intercourse.

The literature focuses mostly on the sexual lives of individuals with physical disabilities; and research on individuals with visual and hearing disabilities is limited. Therefore, the results of the present study will contribute to the literature due to its specific subject and sample.

Limitations

The limitations of the study are that only sexually active disabled males were included in the sample, a higher number of disabled people could not be reached, and their spouses/partners could not be included in the study. The results of this study only reflect its sample and therefore cannot be generalized to the whole population with disabilities. In addition, the study had a cross-sectional design and no follow up was performed.

Conclusions

Individuals with disabilities constitute an important group who should be focused on in terms of reproductive and sexual health. The males with disabilities had basic knowledge about reproductive health and were sexually active, but their disabilities limited their sexual lives. It was determined that the males with physical disabilities experienced more problems with erection and orgasm compared to those with vision and hearing disabilities and were less satisfied with their sexual lives than those with vision disabilities.

Individualized sexual counseling should be offered to the males with disabilities for reproductive and sexual health by well-trained health professionals. The factors preventing individuals with disabilities from accessing health services should be eliminated and these services should be made accessible by taking account of the characteristics of these individuals. Further studies should be conducted to evaluate the reproductive and sexual health of individuals with disabilities.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Conflict of interest statement

No potential conflict of interest was reported by the author(s).

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